‘I was supposed to die’

But judge’s fate was overruled by expert heart team at MMMC

July 11, 2013

WAILUKU - After a morning of presiding over court cases, 2nd Circuit Judge Richard Bissen walked across the street from the courthouse to his doctor's office for his regular checkup.

Just hours later, after undergoing an electrocardiogram at the doctor's office and being sent to Maui Memorial Medical Center for more testing to examine his heart activity, Bissen was taken to the operating room for emergency heart surgery.

"Had I not been in surgery, I would not have made it," Bissen said.

Article Photos

Second Circuit Judge Richard Bissen presides over a sentencing in his courtroom last month. Bissen was back on the bench a month after having emergency heart surgery April 19 at Maui Memorial Medical Center.The Maui News / LILA FUJIMOTO photo

After finding a 95 percent blockage of his left main coronary artery, which runs to both the back and front of the heart, hospital interventional cardiologist Dr. Colin Lee cut short an angiogram to have Bissen immediately taken to surgery. "He literally said I was there in the nick of time," Bissen said. "I had to be exactly where I was. I don't know if I deserve it, but I realize I was given a second chance."

Four days after his April 19 triple-bypass surgery, Bissen was released from the hospital to go home. On May 20, just a month after his surgery, he was back on the bench, at first working part time.

As much as he wanted to keep the matter private, Bissen also wanted to show how thankful he was for the hospital's heart program, its doctors and staff.

"I felt like if I just said, 'Thanks, you did your job,' just let it go, then it would be like I was just taking, I was just a taker," said Bissen, whose life has been marked by public and community service. "But I wanted to be more than that. I'm so grateful."

Before being sworn in as a 2nd Circuit judge in April 2005, Bissen was interim director of the state Department of Public Safety and had been first deputy attorney general for the state. The St. Anthony Junior-Senior High School graduate was Maui County prosecuting attorney from August 1995 to January 2003.

When the 51-year-old Kahului resident offered his help to the hospital, officials asked if he would share his story to help spread the word about the hospital's comprehensive heart program.

"I think Maui should know the resources we have here and we should support this resource," Bissen said. "A lot of people automatically think to go to Oahu.

"All I wanted to emphasize is we have a great facility here with great administrators and great doctors and staff. The lives that these men and women working there will save are our friends and relatives. They will probably save - since I have such a big family - one of my relatives.

"I don't think enough people know about this. If it weren't for them, I wouldn't be alive today."

The hospital heart team includes seven physicians, among them Lee and cardiothoracic surgeon Dr. Michael Dang, who performed Bissen's heart surgery.

Dang said that he used a procedure he developed to put patients on a heart-lung machine so their hearts continue to beat during surgery. "I have been using it for 10 years," Dang said. "Others will stop the heart. When you stop the heart, you have to cool it down and, when you finish, you have to restart it. That always takes its toll. Because I let the heart keep beating, you don't have to restart it, don't have to rewarm it."

Dang said that his surgeries are normally done in two hours, compared with the average of four hours.

Before Dang joined the hospital staff on Valentine's Day 2012, 10 to 12 heart surgeries a year were done there.

Last year, with Dang and fellow cardiac surgeon Dr. Tracy Dorheim on staff, 89 heart surgeries were done at the hospital, up from 18 in 2011. This year, Dang estimates, close to 100 heart surgeries will be performed.

Seventy percent of those operated on are Maui residents, Dang said, with the remaining 30 percent being Big Island residents or tourists.

He said that triple-bypass surgery is "probably the most common operation" done by the heart team. Dang said that Bissen's surgery "was a relatively routine case."

Wes Lo, Maui Memorial chief executive officer, recruited Dang from The Queen's Medical Center on Oahu. "Doctor Dang is a legend at Queen's," Lo said. "He has done more heart surgeries in the last 25 years than anybody in the state of Hawaii. We were very fortunate to have this gentleman be in our midst."

As part of developing the Maui Memorial heart program, Lo also recruited Lee to start the hospital's coronary intervention program two-and-a-half years ago. Lee and Dr. Joseph Chambers lead the interventional cardiology team that has seen an increase in patients while meeting or exceeding many American College of Cardiology standards, according to the hospital.

One standard measuring quality of care for patients who show up at the hospital with emergent major heart attacks is the "door to balloon time," or time it takes from the patient's arrival at the hospital to the inflation of a balloon to open the blocked artery.

The ACC time standard is 90 minutes or less. Since April of last year, the hospital has met that time for 100 percent of patients, Lee said, with an average time of 63 minutes and a record time of 19 minutes.

Lee said that last year, the hospital treated 80 to 90 such patients - "a very high number" for a hospital of its size. According to the hospital, coronary interventions at Maui Memorial more than doubled from 2011 to 2012.

"In a full-blown heart attack, every minute counts," Lee said. "Heart muscle is dying as every minute passes. To delay until you get to Honolulu before you treat a patient may mean the heart attack may be almost completely done by the time you get there. Or worse yet, the patient may not survive.

"The sooner you get the blood flowing, the more heart muscle you save. The more heart muscle you save, the better the patient's survival."

Before the comprehensive heart program was established, 300 to 400 patients a year were being transferred from Maui Memorial to Oahu hospitals for cardiac procedures, Lee said. Last year, he said, the number dropped to 20, all of them Kaiser patients.

That means hundreds of Maui patients have been saved the $14,000 to $18,000 cost and three to six hours it may take to arrange an air ambulance flight to Honolulu, Lee said.

Both he and Dang emphasized that heart team members work together in treating patients. "We're all partners, so there's not competition," Dang said. "We evaluate patients together."

Added Lee: "It's all about what's best for the patient.

"The best justification for us being here is to treat those cases that really can't wait, where every minute counts," Lee said.

He said that was the case for Bissen.

The judge said the events leading up to his lifesaving surgery began with his 11 a.m. appointment April 19 with internist Dr. Nolan Arruda at Maui Medical Group. "A lot of people think I'm hardheaded," Bissen said. "The truth is I follow all the doctor's orders. I have regular checkups."

After Bissen described a lingering cough that caused his chest to feel warm even when he wasn't coughing, a little heartburn and what felt like a pinched nerve running down the left side of his neck for two or three days, Arruda decided to order an EKG that was done there.

He said that Arruda sent the results to Bissen's cardiologist, Dr. Howard Barbarosh. Seeing differences from Bissen's EKG done a year earlier, both doctors decided Bissen needed to go to the hospital emergency room for what he thought would be more tests.

By then, it was about 12:20 p.m. Bissen asked if the tests could wait until after his 1:30 p.m. court session and his 5:30 p.m. commitment to play music with a group at the Wailuku Community Center.

The doctor's answer, Bissen said, was "absolutely not."

Because he reported having no pain, Bissen was told he could drive himself to the emergency room.

So he walked back to the courthouse and asked his judicial assistant to find another judge to handle his afternoon calendar. He called his wife, Isabella, as he was on the way to the hospital. She met him there, along with his oldest daughter, Sayble.

At the emergency room, additional EKGs were done before Lee spoke to Bissen and he was taken to the angiogram lab.

Lee was reviewing the third of several images planned as part of the procedure when he found the artery blockage.

"Because of the path of his pain, we knew we couldn't afford to wait," Lee said. "The pain started to get worse because the blockage was so severe."

Bissen remembers Lee's "calming, unreal demeanor."

"All he said was, 'Hey, Rick, we're not seeing what we expected to see. We're just going to go right to the OR,' " Bissen recalled. "I said, 'Sounds good to me.' "

By then, Bissen's assessment of his pain level had gone from "one" to "nine," and he felt as though his chest was stretching.

"At that time, I had no idea that I was going to have surgery," he said.

About an hour had passed from the time he arrived at the hospital.

In the operating room, Bissen was introduced to Dang and was put under anesthesia.

"Within seconds, I'm out," Bissen said. "Next thing I remember, I was in the ICU."

When he awoke, his first vision was of his youngest daughter, Keapo, who had flown in from the Big Island, where she was attending the University of Hawaii-Hilo. Other friends and family members also were in the room, including daughter Kaanohi.

"My wife told me I had a triple bypass," he said.

Bissen was talking that day, began to sit up the next and soon was walking.

When he was told to walk a certain distance once, he would do it twice. By the third day, after he again exceeded activity benchmarks, Bissen was allowed to walk out to the reception area to see his many visitors.

Four days after his surgery, he was discharged from the hospital.

"I had passed all the milestones. I tried my best to hit them all," he said. "It was excellent care, but I just felt like going home."

First, he had his wife drive him to the barber for a haircut, then to Longs to get his medication before going home and taking a shower.

"All the little things started to be big things, the things you take for granted like a shower, sleeping in your bed, raising your arm," Bissen said. "Everything slowed down."

After talking with his cardiologist later, Bissen said he learned that an acute rupture of plaque in an artery had caused blood to clot and the clotting created the blockage in his artery. It was like a "freak accident," Bissen said, that luckily happened while he was already at the hospital.

"Had I not gone, I would have died on the bench or I would have died playing music at the Wailuku Community Center that night," he said. "I was supposed to die on April 19. These guys saved my life. It's that simple. They were ready and waiting and knew what to do.

"I have played that day back many, many times," he said. "I see it as a complete gift. It was incredible."

As part of the surgery, Dang used 12 titanium screws to secure two titanium plates in Bissen's chest. "I guess he assumed I would continue a pretty active lifestyle," Bissen said.

He said his recovery also was helped by his brother-in-law, Tim, and sister-in-law, Ka'o, who began massaging him, starting in the hospital the day after his surgery and continuing once he was home. The massages helped with his circulation, Bissen said.

"I can't pinpoint exactly what helped me recover so well, from the doctors and medicine, to my genes, to prayers and help from all my friends and family," he said. "It's everything combined, I think."

Five days a week, Bissen walks 45 minutes a day on a treadmill. With a combination of rest, activity and medication, "I'm just trying to follow my body," he said.